Active NPI
Brock Evan Potter, ATC, LAT
- Athletic Trainer
- Evansville, IN
National Provider Identifier
1023584158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36002729A
- Practice address
- 515 Read St
Evansville, IN 47710-1739 - Phone
- (812) 424-9291
- NPI assigned
- Oct 16, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36002729A | IN | Primary |
Addresses
Primary practice location
515 Read St
Evansville, IN 47710-1739
Mailing address
8143 Sail Dr
Evansville, IN 47715-9108
Phone (269) 720-1336
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36002729A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539648000000",
"number": "1023584158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8143 SAIL DR",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477159108",
"telephone_number": "269-720-1336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 READ ST",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477101739",
"telephone_number": "812-424-9291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "BROCK",
"middle_name": "EVAN",
"name_prefix": "Mr.",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-16",
"last_updated": "2018-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36002729A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.